Advertisement

Supportive Care in Cancer

, Volume 26, Issue 7, pp 2247–2250 | Cite as

Ixazomib-induced cutaneous necrotizing vasculitis

  • A. Alloo
  • H. Khosravi
  • S. R. Granter
  • S. M. Jadeja
  • P. G. Richardson
  • J. J. Castillo
  • N. R. LeBoeuf
Original Article

Abstract

Ixazomib is a second-generation proteasome inhibitor that has been approved in the combination treatment of multiple myeloma and is currently under clinical investigation for the management of Waldenstrom’s macroglobulinemia. While cutaneous adverse events secondary to proteasome inhibitors have been reported, the side effect profile of ixazomib remains to be documented. We report two patients, one with multiple myeloma and one with Waldenstrom’s macroglobulinemia, who developed cutaneous necrotizing vasculitis after the initiation of ixazomib. Both patients exhibited no signs of systemic vasculitis and completed their anti-cancer regimens with resolution of their respective eruptions following dose reductions in ixazomib and initiation of low-dose prednisone. A collaborative effort towards the characterization of such cutaneous toxicities facilitates early intervention, maintenance of life-preserving anti-cancer therapy, and allows clinicians opportunity to better understand the pathophysiology of vasculitis. Moreover, appropriate identification and characterization of cutaneous toxicities from novel therapies allows providers to accurately identify safety concerns, treat toxicity, and improve patient quality of life.

Keywords

Ixazomib Proteasome inhibitor Rash Vasculitis Cutaneous toxicity 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Kupperman E, Lee EC, Cao Y et al (2010) Evaluation of the proteasome inhibitor MLN9708 in preclinical models of human cancer. Cancer Res 70(5):1970–1980CrossRefPubMedGoogle Scholar
  2. 2.
    Agterof MJ, Biesma DH (2005) Images in clinical Medicine. Bortezomib-induced skin lesions. N Engl J Med 352(24):2534CrossRefPubMedGoogle Scholar
  3. 3.
    Min CK, Lee S, Kim YJ (2006) Cutaneous leucoclastic vasculitis (LV) following bortezomib therapy in a myeloma patient; association with pro-inflammatory cytokines. Eur J Haematol 76(3):265–268CrossRefPubMedGoogle Scholar
  4. 4.
    Garcia-Navarro X, Puig L, Fernandez-Figueras MT, Dalmau J, Roe E, Alomar A (2007) Bortezomib-associated cutaneous vasculitis. Br J Dermatol 157(4):799–801.  https://doi.org/10.1111/j.1365-2133.2007.08073.x CrossRefPubMedGoogle Scholar
  5. 5.
    Kumar SK, Berdeja JG, Niesvizky R, Lonial S, Laubach JP, Hamadani M, Stewart AK, Hari P, Roy V, Vescio R, Kaufman JL, Berg D, Liao E, di Bacco A, Estevam J, Gupta N, Hui AM, Rajkumar V, Richardson PG (2014) Safety and tolerability of ixazomib, an oral proteasome inhibitor, in combination with lenalidomide and dexamethasone in patients with previously untreated multiple myeloma: an open-label phase 1/2 study. Lancet Oncol 15(13):1503–1512.  https://doi.org/10.1016/S1470-2045(14)71125-8 CrossRefPubMedGoogle Scholar
  6. 6.
    Loree JM, Cai E, Sheffield BS et al (2016) Leukocytoclastic vasculitis following lenalidomide during the treatment of follicular lymphoma. Leuk Lymphoma 58(3):1–4Google Scholar
  7. 7.
    Shirley M (2016) Ixazomib: first global approval. Drugs 76(3):405–411.  https://doi.org/10.1007/s40265-016-0548-5 CrossRefPubMedGoogle Scholar
  8. 8.
    Paulus A, Ailawadhi S, Chanan-Khan A (2016) Novel therapeutic targets in Waldenstrom macroglobulinemia. Best Pract Res Clin Haematol 29(2):216–228.  https://doi.org/10.1016/j.beha.2016.08.020 CrossRefPubMedGoogle Scholar
  9. 9.
    Chhabra S (2017) Novel proteasome inhibitors and histone deacetylase inhibitors: progress in myeloma therapeutics. Pharmaceuticals (Basel) 10(2):40.  https://doi.org/10.3390/ph10020040 CrossRefGoogle Scholar
  10. 10.
    Kim MJ, Kim HO, Kim HY, Park YM (2009) Rituximab-induced vasculitis: a case report and review of the medical published work. J Dermatol 36(5):284–287.  https://doi.org/10.1111/j.1346-8138.2009.00639.x CrossRefPubMedGoogle Scholar
  11. 11.
    Pour L, Hajek R, Zdenek A, Krejci M, Krivanova A, Vorlicek J (2005) Skin lesions induced by bortezomib. Haematologica 90(12 Suppl):ECR44PubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • A. Alloo
    • 1
  • H. Khosravi
    • 2
  • S. R. Granter
    • 3
  • S. M. Jadeja
    • 3
  • P. G. Richardson
    • 4
  • J. J. Castillo
    • 5
  • N. R. LeBoeuf
    • 6
  1. 1.Department of Dermatology, Northwell HealthHofstra Northwell School of MedicineHempsteadUSA
  2. 2.Department of Dermatology, Brigham and Women’s HospitalHarvard Medical SchoolBostonUSA
  3. 3.Department of Pathology, Brigham and Women’s HospitalHarvard Medical SchoolBostonUSA
  4. 4.Dana-Farber Cancer Institute, Jerome Lipper Multiple Myeloma CenterHarvard Medical SchoolBostonUSA
  5. 5.The Center for Hematologic Oncology, Dana-Farber Cancer InstituteHarvard Medical SchoolBostonUSA
  6. 6.Department of Dermatology, The Center for Cutaneous OncologyDana-Farber Cancer Institute and Brigham and Women’s HospitalBostonUSA

Personalised recommendations